Background: Carcinoma pancreas is being diagnosed increasingly with the help of conventional imaging like ultrasonography (USG), computerized tomography (CT) scan and magnetic resonance imaging (MRI).Imaging also gives the opportunity to assess resectability. In our country MRI and CT scan are not widely available and most of the pancreatic carcinoma is too advanced for curative surgical resection when diagnosed. These are unresectable carcinoma pancreas (UCP). Objectives: To evaluate the efficacy of imaging in diagnosing carcinoma pancreas and to assess resectability after comparing them with peroperative findings. Methods: This retrospective study was carried out in the department of Hepato-Biliary-Pancreatic Surgery in Bangladesh Institute for Research and Rehabilitation in Diabetic Endocrine and Metabolic disorders (BIRDEM) hospital, Dhaka, Bangladesh from July 2004 to June 2006 (2 years). After laparotomy findings and histopathological confirmation 50 patients were labeled as UCP. Among 50 patients male were 28 & female patients were 22. Imaging modalities used before surgery was assessed and compared with per operative findings. USG were done in all patients and CTscan in 45 patients. MRI was done in 08 patients suspected clinically as pancreatic carcinoma where USG /CT scan had failed to reach a conclusion. Findings of the various imaging studies regarding diagnosis and unresectability were compared with per operative findings. Results: USG was able to diagnose 42 (84%) pancreatic carcinoma patients with unresectibility in 29 (69%). Forty five patients (90%) were diagnosed by CT scan and could label 38 (84.44%) as unresectable. MRI was 100% accurate to diagnose and label the entire 08 patient as unresectable carcinoma pancreas. Cumulative multimodal preoperative imaging was 91.33% accurate in diagnosing carcinoma pancreas and could tell the features of unresectibility in 73.59% patients. Conclusion: CT scan should be the primary imaging modality for diagnosing pancreatic carcinoma and its resectability. MRI is very promising for diagnosing and assessing UCP. Multimodal imaging is better than single imaging.
Background: Some hospitalized patients may not be able to eat and drink and often have depleted fluid levels and electrolyte imbalance. So, intravenous (IV) fluid therapy is a part of everyday clinical practice. Aims: This study was carried out to assess the extent of rational use of IV fluid in indoor patients of medicine wards of Chittagong Medical College Hospital (CMCH). Materials and methods: This cross sectional observational study was done in CMCH from April to November 2014. One hundred and ninety four (n=194) patients getting IV fluid were selected by purposive sampling. All relevant information for each study subject was collected by ‘Observing Method’ using a data collection sheet after getting informed written consent. Variables were checked. Results were matched with standard guidelines. Results: Male patients were 1.3 times more than female. Acute abdomen (20.62%) Acute febrile illness (11.85%) Poisoning (11.34%) Stroke (10.31%) and Acute watery diarrhea (9.28%) were common indications for giving IV fluid. Status of hydration was properly assessed in 82.99% patients. Commonly used fluids were 5% DNS (34.02%) NS (17.01%) CS (7.22%). Amount of fluid was appropriate in 90.20% patients but constituents were appropriate only in 52.06% patients. Most of the patients (76%) had received IV fluid for one day. Thirteen (6.70%) patients had suffered from IV fluid related complications. Conclusion: Considering assessment of status of hydration, amount and constituents of fluid, 64 (33%) patients had received IV fluid in a rational way. This study highlights the importance of multicentre study to formulate a national guideline. JCMCTA 2017 ; 28 (1) : 32 - 37
Although clinical findings along with modern laboratory investigations and imaging can help to diagnose pancreatic cancer and label them respectable or unrespectable, tissue diagnosis is essential to confirm the diagnosis and proper management. This retrospective review was done form July 2004 to June 2006 in BIRDEM hospital, Dhaka, Bangladesh, in patient with clinically labeled 'unresectable carcinoma pancreas' to evaluate the preoperative and postoperative biopsy pattern with their histopathological diagnosis. Forty (40) patients were clinically labeled as ‘unresectable carcinoma pancreas'. Preoperative image guided biopsy was taken in 25 patients. Methods of preoperative tissue diagnosis with their histopathology reports were noted. In forty (40) patients it was planned to take open biopsy along with other palliative surgical procedures. In 38 patients tumours found unresectable and biopsy were taken from the lesion, involved organ or lymph node. In 2 patients curative resection were done and whole specimens were sent for histopathology. Histopathology report of post surgical specimen was compared with preoperative histopathology report. Preoperative biopsies were done by ERCP in 12 patients. Ten (10) image (ultrasonography, computed tomography scan) assisted fine needle aspiration biopsy were taken from the pancreatic lesion. Preoperative imaging failed to detect any pancreatic mass in the rest 3 patients but showed suspected liver metastasis. Image (computed tomography scan) assisted 03 fine needle aspiration biopsies were taken from 3 hepatic metastasis. Histopathological report showed pancreatic duct cell carcinoma in 19 (76%) patients, 1(4%) patients had chronic pancreatitis. Biopsy report was not conclusive in 2 (8%) patients. All 3 biopsies from liver focus were metastatic pancreatic cancer (12%). Histopathology report of laparotomy samples revealed that 35 patients (87.5%) had pancreatic duct cell carcinoma. Out of the rest 5 patients 2 patients (5%) were chronic pancreatitis, non Hodgkin's lymphoma 01 patients (2.5%), tuberculosis 01patients (2.5%) and metastatic renal cell carcinoma 01 patient (2.5%). Open biopsy has a greater diagnostic accuracy than preoperative biopsy in diagnosing unrespectable pancreatic carcinoma and to exclude other pancreatic mass lesions labeled clinically as ‘unrespectable carcinoma pancreas'. Open biopsy is recommended in clinically labeled 'unrespectable carcinoma pancreas'. JCMCTA 2012 ; 23 (2): 53-57
Background: At the time of diagnosis most of the pancreatic caner is well advanced and curative resection becomes impossible. These are labeled as unresectable carcinoma pancreas where only palliative medical or surgical measures could be done.
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